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Absences Leave Request
Note this form must be completed and will become a part of your personnel record
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Email
*
Your email
Your Name
Your answer
Date requested off
MM
/
DD
/
YYYY
Total #of days in half day increments, if half day please indicate AM/PM
Full Day
Half day
2 days
3 days (if three in a row illness days a doctor note is requested)
4 days
5 days
Other:
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If cancelling a previous request please indicate here
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